North Carolina State Bar REPORT DATE: ______________20______
Quarterly Trust Account Review Report Account Name: ______________________
Rule 1.15-3(i) Random Transaction Review Account #: ______________________
GENERAL INFORMATION
Complete one form for each general trust account, dedicated trust account, and fiduciary account
Attach the following for each transaction: statement of costs and receipts, client ledger, cancelled checks or
images thereof, any other documentation necessary to complete review, and any required explanations
At least three transactions shall satisfy the requirement in Rule 1.15-3(i), but a larger sample may be advisable
Transaction #1
1. Client Name/Matter: ______________/________________ Date Range of Disbursement(s) __________:__________
2. Does client ledger show a negative balance? □ Yes □ No If yes, attach explanation and corrective action.
3. Lawyer reviewed the following: Statement of Costs and Receipts □ Yes □ No
(Attach to Report) Client Ledger □ Yes □ No
Cancelled Checks (or images thereof) □ Yes □ No
Other _________________________ □ Yes □ No
4. Did the transaction involve multiple disbursements? □ Yes □ No Number of disbursements _________________
5. Are any disbursements outstanding? □ Yes □ No If yes, attach explanation and corrective action.
6. Were any disbursements improperly made? □ Yes □ No If yes, attach explanation and corrective action.
Transaction #2
1. Client Name/Matter: ______________/________________ Date Range of Disbursement(s) __________:__________
2. Does client ledger show a negative balance? □ Yes □ No If yes, attach explanation and corrective action.
3. Lawyer reviewed the following: Statement of Costs and Receipts □ Yes □ No
(Attach to Report) Client Ledger □ Yes □ No
Cancelled Checks (or images thereof) □ Yes □ No
Other _________________________ □ Yes □ No
4. Did the transaction involve multiple disbursements? □ Yes □ No Number of disbursements _________________
5. Are any disbursements outstanding? □ Yes □ No If yes, attach explanation and corrective action.
6. Were any disbursements improperly made? □ Yes □ No If yes, attach explanation and corrective action.
Transaction #3
1. Client Name/Matter: ______________/________________ Date Range of Disbursement(s) __________:__________
2. Does client ledger show a negative balance? □ Yes □ No If yes, attach explanation and corrective action.
3. Lawyer reviewed the following: Statement of Costs and Receipts □ Yes □ No
(Attach to Report) Client Ledger □ Yes □ No
Cancelled Checks (or images thereof) □ Yes □ No
Other _________________________ □ Yes □ No
4. Did the transaction involve multiple disbursements? □
Yes □ No Number of disbursements _________________
5. Are any disbursements outstanding? □ Yes □ No If yes, attach explanation and corrective action.
6. Were any disbursements improperly made? □ Yes □ No If yes, attach explanation and corrective action.
Lawyer Certification
I certify that I personally randomly selected the above transactions, that I personally conducted the review, and that all
discrepancies shall be investigated, identified, and resolved within ten days of this review.
_________________________ ___________________________ _____________ ______________________
Lawyer Name Signature Date Firm Name
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